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Peer-reviewedCC BY-NCBMJ neurology open

Anti-Ma1/Ma2 paraneoplastic neurological syndrome associated with malignant mesothelioma: a case study.

  • Amir Mousapasandi1,2
  • Stephen Evans2
  • Gi Tae Kwon1
  1. 1Neurology Department, Nepean Hospital, Penrith, New South Wales, Australia.
  2. 2Neurology Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
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Abstract

Introduction

Anti-Ma1/Ma2 paraneoplastic neurological syndromes (PNS) are rare immune-mediated disorders classically associated with testicular germ cell tumours but increasingly recognised in a broader range of malignancies.Methods

We report a 74-year-old left-handed man who presented with progressive gait ataxia. MRI of the brain showed T2 hyperintensity in the right amygdala and hippocampus, as well as in the left caudate head. Serum and cerebrospinal fluid tested positive for anti-Ma1/Ma2 antibodies. Despite extensive screening, no malignancy was identified.Results

Neurological deficits worsened over 2 months, including worsening gait, ataxia, opsoclonus and left arm weakness. High-dose corticosteroids, intravenous immunoglobulin, mycophenolate and rituximab led to modest clinical improvement. 4 months later, the patient re-presented with insidious respiratory distress due to a right pleural effusion. Pleural biopsy confirmed mesothelioma. Anti-Ma1/Ma2 PNS linked to mesothelioma are rare but have been reported.Conclusions

For this rare association, previous few cases described neurological symptoms emerging months to years after a mesothelioma diagnosis, while ours is the first to report symptoms preceding diagnosis. Early immunosuppression can provide temporary clinical benefit. A more sustained benefit requires identification and treatment of the underlying malignancy. This case underscores the importance of ongoing surveillance for malignancy in patients with PNS.

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Cite

BibTeXRIS
BibTeX
@article{mousapasandi2026antima1ma2,
  title = {{Anti-Ma1/Ma2 paraneoplastic neurological syndrome associated with malignant mesothelioma: a case study.}},
  author = {Amir Mousapasandi and Stephen Evans and Gi Tae Kwon},
  journal = {BMJ neurology open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjno-2025-001323},
  url = {https://europepmc.org/article/MED/42948236},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Anti-Ma1/Ma2 paraneoplastic neurological syndrome associated with malignant mesothelioma: a case study.
AU  - Amir Mousapasandi
AU  - Stephen Evans
AU  - Gi Tae Kwon
PY  - 2026
DA  - 2026/10/23
JO  - BMJ neurology open
DO  - 10.1136/bmjno-2025-001323
UR  - https://europepmc.org/article/MED/42948236
AB  - Introduction  Anti-Ma1/Ma2 paraneoplastic neurological syndromes (PNS) are rare immune-mediated disorders classically associated with testicular germ cell tumours but increasingly recognised in a broader range of malignancies.Methods  We report a 74-year-old left-handed man who presented with progressive gait ataxia. MRI of the brain showed T2 hyperintensity in the right amygdala and hippocampus, as well as in the left caudate head. Serum and cerebrospinal fluid tested positive for anti-Ma1/Ma2 antibodies. Despite extensive screening, no malignancy was identified.Results  Neurological deficits worsened over 2 months, including worsening gait, ataxia, opsoclonus and left arm weakness. High-dose corticosteroids, intravenous immunoglobulin, mycophenolate and rituximab led to modest clinical improvement. 4 months later, the patient re-presented with insidious respiratory distress due to a right pleural effusion. Pleural biopsy confirmed mesothelioma. Anti-Ma1/Ma2 PNS linked to mesothelioma are rare but have been reported.Conclusions  For this rare association, previous few cases described neurological symptoms emerging months to years after a mesothelioma diagnosis, while ours is the first to report symptoms preceding diagnosis. Early immunosuppression can provide temporary clinical benefit. A more sustained benefit requires identification and treatment of the underlying malignancy. This case underscores the importance of ongoing surveillance for malignancy in patients with PNS.
SN  - 2632-6140
ER  -